title: Virtual surgical planning in endoscopic skull base surgery.
abstract: OBJECTIVE
  Skull base surgery (SBS) involves operative tasks in close proximity to critical structures in a complex three-dimensional (3D) anatomy. The aim was to investigate the value of virtual planning (VP) based on preoperative magnetic resonance imaging (MRI) for surgical planning in SBS and to compare the effects of virtual planning with 3D contours between the expert and the surgeon in training.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Twelve patients with manually segmented anatomical structures based on preoperative MRI were evaluated by eight surgeons in a randomized order using a validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire.
  
  
  RESULTS
  Multivariate analysis revealed significant reduction of workload when using VP (P<.0001) compared to standard planning. Further, it showed that the experience level of the surgeon had a significant effect on the NASA-TLX differences (P<.05). Additional subanalysis did not reveal any significant findings regarding which type of surgeon benefits the most (P>.05).
  
  
  CONCLUSIONS
  Preoperative anatomical segmentation with virtual surgical planning using contours in endoscopic SBS significantly reduces the workload for the expert and the surgeon in training.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University Health Network/Toronto General Hospital, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Stephan K
authors.initials: SK
authors.lastname: Haerle
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Daly
authors.forename: Harley H L
authors.initials: HH
authors.lastname: Chan
authors.forename: Allan
authors.initials: A
authors.lastname: Vescan
authors.forename: Walter
authors.initials: W
authors.lastname: Kucharczyk
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
mesh_terms: D004503:Education, Medical, Graduate; D004724:Endoscopy / Q000193:education* / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000193:education* / Q000379:methods; D014584:User-Computer Interface
keywords: Skull base surgery; contouring; image guidance; surgical planning